HomeMy WebLinkAboutF2023-0522 - Permit ApplicationWorksheet for Fire Permit Applicati of
Print Form City of Newport Beach - Building Division k
Please print 3 copies
Associated Building Permit # r Fire Sprinkler F_ Fire Alarm ,Fire Misc
1. Project Address (Not mailing address) Floor Suite No
NeV,)?C) k CeAke(- 4��a �— I—
Tenant Name I \V A A L` ,MO y2vt-vv� S
2. Description of Work
# Units �-
11 r I / I Use
TM�t t6kkDv� O� o.V \ _C4Xv'�� aillf��ra5� on.
S Sy 5}evn .
Valuation $ 2�p o
Extg Sq Ft �— New/Added Sq Ft — Total Sq Ft �O D
# Stories
PC New r Add F_ Alter r Demo
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last F
First F_
Owner's Address
Owner's E-mail Address
City
State �--� Zip F_ Telephoned
F_ 4. Architect/Designer's Name
Last First F Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I�
State I Zip F— Telephoned®
F_ 5. Engineer's Name Last
First F Lic. No. r
Engineer's Address
Engineer's E-mail Address
City
State F— Zip F_ TelephoneF—
X6.Contractor'sName Last C�{TItLl7 First e W� Lic No. �b°IiQ�ClassF—
Contractors Address
Contractor's E-mail Address
(
-5681,�: 9,wf', V"V%J
City WS t
State C Zip g0OD� Telephonef
OFFICE USE ONLY Sys +^� # �'W2&- ig,2- PERMIT NO.
TYPE OF CONSTRUCTION
�Q�' DZ�� PLAN CHECK
OCCUPANCY - GROUP
�� PLAN CHECK FEE $